Growing for the future

Former Packard Children's Hospital patients Nicole Neal and her daughter, Audrey Harmony, now a thriving 6-month-old, came back for a visit on groundbreaking day in September.

Trucks, hardhats and backhoes have been a familiar sight around Lucile Packard Children’s Hospital at Stanford for the past year, preparing the groundwork and relocating key structures, such as water lines. Now the hospital is officially on its way toward a major expansion.

Over the next few years, Packard Children’s will add 521,000 square feet of new building space and more than 3.5 acres of gardens and landscaping. The expansion will add 150 patient rooms—146 of them private—as well as specialized operating rooms, family-friendly amenities and the most advanced medical technology. The new addition is scheduled to open December 2016.

“The biggest change will be in accessibility,” said Craig Albanese, MD, the John A. and Cynthia Fry Gunn Endowed Director of Pediatric Surgical Services. “We’re adding more acute and intensive care beds and almost doubling our operating rooms. These changes will help ensure that the children and expectant mothers who need our care will not be turned away for lack of space.”

Though the original children’s hospital dates back almost 100 years, the current facility opened its doors in 1991. Since then technology has changed dramatically, as have the needs of the patients who come to Packard Children’s for care.

“The new hospital has been designed not only for our patients today but also for their needs in the future,” said Packard Children’s President and CEO Christopher Dawes. “It will incorporate the very latest medical technology while also providing more privacy and more space for families to be with their sick child or pregnant spouse.”

Efficiency and safety

The expansion will feature not only amenities dedicated to family needs—like private rooms, quiet waiting areas and age-appropriate playrooms—but space designed to make work more streamlined and effective, such as centralized meeting rooms, adjacent storage for medical supplies, outdoor break areas for staff and onsite locker rooms and showers.

“It’s not just about bricks and mortar—all the workflow details have been taken into consideration and incorporated,” said Denise Bickert, MS, RN, administrative director of perioperative services. “Everything will be organized more logically, with larger rooms and efficient set-ups.”

Patient rooms are spacious, bright and arranged for families to stay with their kids in comfort. Rooms have fold-out double beds, built-in closets, large flat-screen TVs and private bathrooms with showers. They also are designed for safety, with an in-room nurse workstation and a sink by the door for hand washing. Doors to the bathrooms are extra wide to allow easy access in case of emergency.

“The rooms are designed for quiet and rehabilitation,” said Michael Edwards, MD, chief of pediatric neurosurgery. “The goal is to help patients begin the recovery process in an environment created for healing so that they can return home sooner.”

Planners estimate the layouts will cut down the steps nurses must walk each day by 50 percent: Computer consoles between each room will allow nurses and physicians to update medical records close to the bedside, and medication alcoves will enable nurses to prepare and sort drugs without interruption.

“There is a subtle delineation, so caregivers have the space to do their job without intruding on the family’s privacy,” Bickert said. “That means the work flow will go smoothly on our end, and children and families will receive more streamlined care.”

Expanded space also means that services now located across Welch Road can be consolidated, cutting back trips across the street for both patients and employees.

“The design is not just friendlier to families but to employees as well,” said Jill Sullivan, MSN, RN, vice president of hospital transformation. “We’ll be able to incorporate services, which will be easier for everyone.”

Blended technologies

The addition of seven new operating rooms will cut down on scheduling delays and wait times. Two of the ORs are specialized hybrid rooms with fully integrated, state-of-the-art diagnostic imaging equipment. Surgeons will be able to collaborate with anesthesiologists and radiologists and use rapidly updated images during procedures like repairing a malformed heart or removing a brain tumor. Patients will not need to be moved to another room for CT scans, MRIs or catheterization procedures.

“A big attraction is that these ORs are highly flexible,” said Albanese. “You can use them as a cardiovascular or neurological surgical suite or as a general operating room, with the imaging equipment available for others to use.”

Surgeons will be able to reimage a patient immediately after a procedure to ensure that the operation was successful, which shortens time in the operating room—and recovery time. Pre-op areas will provide more privacy and allow parents to stay with their kids while they are being prepped for surgery in areas designed for quiet and calm.

“Surgery for a child is a scary thing for parents, so anything we can do to minimize the stress is a great thing,” said Anita Honkanen, MD, chief of pediatric anesthesia. “The design allows us to provide seamless care because there are so many efficiencies in how the suites are laid out. The right things are in the right place, which means we will all be able to do our jobs more efficiently and safely.”

Another plus, according to Albanese, is that advanced facilities will be an enticement to recruiting top physicians, surgeons and nurses. “Technology changes the way we confer care to our patients,” he said. “It’s a reflection of our connection to an academic medical center and with Silicon Valley. These advanced facilities will bring the kind of people here who are eager to improve how we treat pediatric patients.”

Planning process

Mockups of the ORs and two kinds of patient rooms were constructed off-site and assessed by representatives of everyone who would use them: surgeons, radiologists, nurses and parents. More than 800 people were involved in the planning process and took part in a number of scenarios to see what worked—and what needed to be changed. Their feedback was tracked and incorporated by the hospital architects, engineers and contractors.

“Not one room stayed as originally designed,” said Sullivan. “No one knows how equipment should be laid out better than the people who actually use it.”

In the ICU rooms, for example, monitors were moved overhead to allow 360-degree access to the child’s bed and bathtubs were moved for a more logical floor plan. Reading lights have been placed near the spare bed, and medical console outlets were rearranged. In the hybrid ORs, MRI magnets were repositioned, lights and screens were placed for better visibility, electrical cords were lengthened and room controls were centralized.

“The rooms have been built around the surgical procedures. In neurosurgery, in particular, patients need to be placed in different positions, and each position requires a different room set-up,” Edwards said. “We had a walkthrough for every position, with every member of the team: How will this work? Where will we stand? Where is the equipment? It was amazing how many details we were able to improve.”

The big picture

The hospital’s research, programs and services attract patients from around the world. Its clinical care is consistently ranked by U.S. News & World Report as among the nation’s best. State-of-the-art facilities will help to attract the most promising young physicians and surgeons and inspire innovation, Edwards said. And because technology continues to change every aspect of patient care, the plans are adaptable enough to accommodate new protocols and equipment as they develop.

“We will be able to modify rooms, layouts and diagnostic areas so we can continue to adapt to changes and advances in health care,” Dawes, the CEO, said. “Packard Children’s already makes a tremendous impact. This expansion will allow us to continue our work and add more services.”

While the construction is under way, the hospital will make more advances in identifying, developing and implementing patient- and family-centered care, training leaders and advancing science, he added.

“It all adds up to a better place to work, which of course reflects back to our patients and families,” said Albanese.